Embodiments of the invention relate to deflecting emboli in an aorta to prevent emboli from entering arteries, for example, arteries that lead to the brain.
Devices such as vascular filters or other devices may be inserted into a blood vessel prior to or during a procedure or at another time. Such devices may be inserted by way of a catheter that may be, for example, threaded through a vein or artery, and into, for example, an aorta or other vessel where the device may be released from the catheter and, for example, deployed. The device may filter, deflect, or block emboli or other objects from entering into a blood supply that feeds the brain.
In one aspect, the invention features an intravascular device including a first wire, a second wire, and a connecting element; wherein:
a. the connecting element includes a hollow cylindrical body defining an internal channel along a longitudinal axis;
b. the connecting element joins the first wire and the second wire;
c. the connecting element includes a first stop element;
d. the second wire includes a second stop element; and
e. the first stop element is configured to reversibly engage the second stop element such that the second wire is only able to freely rotate relative to the connecting element over a distance of between 10 and 360 degrees. For example, the device can freely rotate relative to the wire approximately 10, 20, 30, 40, 50, 60, 70, 80, 90, 120, 145, 160, 180, 210, 240, 270, 300, 330, or slightly less than 360 degrees (e.g., the wire can rotate at least 10, 20, 30, 40, 50, 60, 70, 80, 90, 120, 145, 160, 180, 210, 240, 270, 300, 330, or slightly less than 360 degrees or at most 10, 20, 30, 40, 50, 60, 70, 80, 90, 120, 145, 160, 180, 210, 240, 270, 300, 330, or slightly less than 360 degrees).
In some embodiments, the hollow cylindrical body includes a window having two edges substantially parallel to the longitudinal axis and the edges reversibly engage the second stop element thereby defining the first stop element. In related embodiments, the first stop element is disposed within the window. In other embodiments, the first stop element is disposed on the interior of the hollow cylindrical body.
In the above and related embodiments, the second stop is a protrusion disposed on the surface of the second wire. Alternatively, the second stop element includes a substantially cylindrical element that is disposed about the second wire or joined to an end of the second wire, the substantially cylindrical element including a window having two edges substantially parallel to the longitudinal axis that reversibly engages the first stop element. In one particular embodiment, the second stop element includes a substantially cylindrical element that is disposed about the second wire or joined to an end of the second wire, the substantially cylindrical element including a window including:
(i) two edges substantially parallel to the longitudinal axis that reversibly engage the first stop element; and
(ii) a third edge substantially orthogonal the longitudinal axis.
This embodiment may also feature the joining of the second wire and the connecting element by bending the first stop such that it is disposed within the window in the substantially cylindrical element, thereby permitting reversible engagement with the second stop element. Here, for example, upon disposition within the window in the substantially cylindrical element, the second stop element reversibly engages the third edge, thereby preventing separation of the second wire and the connecting element.
In another aspect, the invention features a device for deflecting emboli, the device including:
In certain embodiments, the radiopaque elements are located exclusively at the following positions: a junction between the lateral structure and lower member, a junction between the lateral structure and upper member, at the top of the upper member, and, optionally, at the distal and proximate ends of the lateral structure.
In the following description, various embodiments of the invention will be described. For purposes of explanation, specific examples are set forth in order to provide a thorough understanding of at least one embodiment of the invention. However, it will also be apparent to one skilled in the art that other embodiments of the invention are not limited to the examples described herein. Furthermore, well-known features or processes may be omitted or simplified in order not to obscure embodiments of the invention described herein.
In general the invention features an element for connecting an intravascular device (e.g., the devices described in International Application Number PCT/IL2011/000963, incorporated by reference in its entirety) to a wire. The invention also features certain arrangements of radiopaque elements on intravascular devices, e.g., the devices described in International Application Number PCT/IL2011/000963.
Reference is made to
Imaginary line 116 represents a theoretical lateral plane of device 100. In some embodiments, a lateral plane of device 100 may include an approximately horizontal line tracing a middle section of skeleton 102 along device 100 before the curves of end 112 and end 114.
A first support portion 118 of upper member 110, as may be proximate to skeleton 102, may rise away from skeleton 102 at an angle towards first end 112. A second anchor portion 120 of upper member 110 may double back on such first support portion at bend 122 and may rise upward and towards a direction of second end 114. Second anchor portion 120 of upper member 110 may taper in width towards its tip, which may be rounded or flattened.
In some embodiments, a weave of strands 107 of filter 104 may be angled at approximately 45 degrees to an outside of skeleton 102 to accommodate shifts in length or with of the structure of skeleton 102 when device 100 is installed, removed or positioned into place.
Reference is made to
Upon deployment, installation or release, upper member 110 may extend into an innominate artery. For example, first support portion 118 of upper member 110 may come into contact with a right internal wall of the innominate artery, bend 122 may come into contact with a right internal wall of the innominate artery, and second anchor portion 120 of upper member 110 may come into contact with a superior portion of a left internal wall of the innominate artery. The multiple, possible contact or holding points of upper member 110 with the innominate artery may hold device 100 in place against a blood flow in the aorta, may prevent a roll of device 100 within the aorta, and may prevent device 100 from rising beyond a desired distance from an entry point of the innominate, left carotid and left subclavian arteries. Upper member 110 may also prevent device 100 from sliding out of position in a direction of a blood flow or of reverse flow in the aorta. Upper member 110 may exert a downward force on device 100 to counter a lift that may be exerted by lower members 106 and 108, and to keep device 100 away from the entry points of the branch arteries of the aorta, for example, as are listed above.
In some embodiments, upper member 110 may be inserted into, for example, a left subclavian artery where a curve of bend 122 may be held against a left inner wall of left subclavian artery, and second anchor portion 120 engages a counter wall.
The downward curve of first end 112 and second end 114 may likewise press against an ascending aorta and descending aorta respectively, to prevent a rise of device 100 past a desired position that approximates a midway between a lower wall of the aortic arch and an upper wall of the aortic arch. The downward curve of first end 112 and second end 114 may allow pressure to be exerted against walls of the aorta without damaging or puncturing such walls. Lower members 106 and 108 may exert a continuous lift force on skeleton 102 to keep first end 112 and second end 114 in pressure contact with an upper wall of the ascending aorta and descending aorta respectively.
In an installed position, mesh or filter 104 may block or deflect emboli or other particles from entering, for example, the three branch arteries listed above, while still preserving a space above the filter for blood to swirl and collect at such entries. The space under filter 104 may allow unfiltered blood to pass by the branch arteries of the aorta. Such space in the aorta that is left below the filter means that not all blood passing through the aorta is subject to the filtering or deflecting process of filter 104. Installation in a middle (such as between an upper wall of the aortic arch and a lower wall of the aortic arch) of the aorta rather than directly abutting an entry point into the branch arteries may allow a continued flow of blood both through the aorta and into the branch arteries, even if a portion of filter 104 is clogged with embolic or other material.
In some embodiments, lower member 106 may be connected to skeleton 102 on a first side (such as a dorsal side), and lower member 108 may be connected to skeleton 102 on a second side (such as a ventral side). A first portion of each of lower member 106 and lower member 108 that are proximate to skeleton 102 may extend in substantially parallel lines from skeleton 102. A second or lower portion of each of lower members 106 and 108, as are distal to skeleton 102 may curve towards each other at a point approximating a mid-line of skeleton 102. The lower ends of lower members 106 and 108 may terminate in, for example, small loops of the single wound strand that each of the members includes. Such curved endings may prevent a scratching or abrasion of an end of the lower member 106 or 108 against arterial tissue. The ends of each of lower members 106 and 108 may in some embodiments touch gently together though they may separate with light pressure.
In some embodiments device 100 may remain positioned in an aorta while a procedure (e.g., transcatheter aortic valve implantation) is undertaken in, for example, a heart, blood vessel, or other in-vivo area, where such procedure entails tracing a lead such as a catheter through the aorta. The ease of separation of lower members 106 and 108 may allow a removal of an arterial catheter or other device from the aorta while device 100 remains in place, and serves to deflect or filter embolic material away from entering branch arteries of the aorta.
Reference is made to
In some embodiments, device 100 may prevent the passage of, block, divert, or filter-out particles, such as, for example, blood clots, calcified debris or other objects that may block a flow of blood. Skeleton 102 and device 100 may also be used to support or keep in place other apparatuses. In some embodiments, device 100 may be inserted into a vessel by way of, for example, a catheter, and may be threaded into, for example, a blood vessel into which device 100 may be implanted. Other methods of implanting device 100 into a blood vessel are possible. In some embodiments, device 100 may assume a shape of an extended oval or a willow leaf. Other shapes may be used.
In some embodiments, skeleton 102 may include or be constructed of, for example, Nitinol or other superelastic or shape memory alloy or material. Other materials may be used. In some embodiments, filter 104 may be or include a fine wire netting or mesh, or perforated film, such as a mesh having holes or pores of 300 microns more or less such that, for example, particles that are larger than the pores or holes are prevented from passing through the filter. Other sizes of holes or eyes may be used. In some embodiments, a shape of filter 104 may be defined or supported by a shape of skeleton 102.
In some embodiments, one or more of skeleton 102, upper member 110 and lower members 106 and 108 may be fashioned of continuous wire that has different thicknesses or properties in various areas of its lengths. For example, upper member 110 may be fashioned of a wire or portion of wire that is thin or otherwise highly flexible relative to the thickness or flexibility of one or more of lower members 106 and 108 or of other portions of skeleton 102. Such heightened flexibility may enable upper member 110 and particularly bend 122 and second portion 120 to expand or shrink upon the application of even a small force, such as, for example, the small force exerted by the contact of upper member 110 with an upper portion of a blood vessel against which it comes into contact. In contrast, lower members 106 and 108 may be fashioned of a thicker or relatively more rigid wire or filament to provide lift for a mid portion of device 100.
In some embodiments, one or more of the wires that make up upper member 110 and lower members 106 and 108 may be wound or braided around skeleton 102, and no soldered or glued connections between the wound strands of skeleton 102 and members 110, 106 and 108 may be needed.
In some embodiments, device 100 may be inserted or deployed through, for example, one of the branch arteries or directly through an artery in the area of the heart rather than by way of a catheter from a remote vessel.
Reference is made to
In block 404, a lower member connected with the device may extend downward from the lateral structure in a direction of an upstream blood-flow, and such lower member may exert a lift on a middle area of the lateral structure.
In block 406, an upper member that may be connected to the structure, may be angled in a proximate section towards upstream flow of blood in the aorta, and in a distal section relative to the device, may be angled towards downstream flow of blood in the aorta, where a bend in such upper member between the support portion and the anchor portion, may extend into a location approximating a position of an innominate artery.
In block 408, the upper member may limit the lift provided by the lower member so that the device maintains a relatively horizontal position within a middle area of the aorta.
In some embodiments, the structure is bent downward from its lateral plane on each of a first end and second end of the structure, and outward force is exerted from each of such first end and a second end of the structure upon an inner wall of an ascending aorta and descending aorta, respectively.
In some embodiments, the embolic material is filtered from entering the branch arteries of the aorta.
In some embodiments, a method may include snaring a hook at a downstream end of the device with a loop brought into contact with the hook.
In some embodiments, a method may include separating a contact of a first side of the lower member from a second side of the lower member by pulling another device through the aorta to an area bounded by the lateral structure and the first and second sides of the lower member.
In some embodiments, a method may include bending an inferior or lower portion of the first side of the lower member towards an inferior or lower portion of the second side of the lower member.
In some embodiments, the invention may feature a method of manufacturing a device of the invention by tapering or narrowing the distal end of the upper member after the bend of the upper member so that the upper member ends in a narrow, curved point.
In some embodiments, a method may include winding a strand of structural material around the lateral structure, and extending such wound strand into one or more of the upper and lower members respectively. In some embodiments, the entire frame may be fabricated from a foil sheet that includes both the frame and the filter.
In particular embodiments, the present intra-vascular device may include elements that permit the determination of the orientation of the intra-vascular device in three-dimensional space. For instance, the intra-vascular device may include elements that allow the orientation of device to be determined when the device is present within a subject. The capacity to reveal the orientation of the intra-vascular device even when visual contact with the device is not available may be of value to practitioners.
In certain embodiments, the intra-vascular device may include radiopaque elements positioned such that, when the positions of some or all of the radiopaque elements are known, the orientation of the intra-vascular device in three-dimensional space may be determined In particular embodiments, the intra-vascular device may include three or more radiopaque elements. For instance, the intra-vascular device may include 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, or 100 or more radiopaque elements.
In some embodiments of the present invention, radiopaque elements are positioned such that a particular orientation of the radiopaque elements could equate to one and only one orientation of the intra-vascular device. When the present intra-vascular device includes three or more radiopaque elements, the elements may be spatially arranged in an asymmetric manner with respect to at least one axis or dimension. For instance, the radiopaque elements may be spatially arranged in an asymmetric manner with respect to one, two or three axes or dimensions. In particular embodiments, the radiopaque elements are asymmetric with respect to two or three axes or dimensions (e.g., as depicted in
A radiopaque element of the present invention may be a radiopaque clamp or bead affixed to or incorporated into the intra-vascular device. In the case of a clamp, the element can be crimped onto the intra-vascular device. A radiopaque element may be affixed to or incorporated into any aspect of the intra-vascular device. For instance, a radiopaque element such as a radiopaque bead or clamp may be an element affixed to or incorporated into the skeleton of the intra-vascular device. In particular embodiments, one or more beads or clamps may be affixed to or incorporated into one or more of the top of the upper member, either or both of the left and right aspects of the upper member, either or both of the left and right lower members, a tip of the intra-vascular device, the filter skeleton, clasp, or the filter material, e.g., mesh material. A radiopaque element may be proximal to or distal from a junction of the intra-vascular device, or at an extremity of the intra-vascular device. It will be understood by those of skill in the art that the precise locations or distribution of the radiopaque elements will not determine the utility of the radiopaque elements.
A radiopaque element may be an element affixed to or incorporated into the wire forming the intra-vascular device or the filter mesh of the intra-vascular device. A radiopaque element may be a radiopaque wire such as a Drawn Filled Tubing (DFT wire). Such wire can contain, e.g., a core of tantalum and/or platinum and an outer material of, e.g., Nitinol (see, e.g.,
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In one embodiment of the invention, the invention feature an element connecting the wire to the intravascular device that permits free rotation of the device relative to the wire over a defined angle. For example, the device can freely rotate relative to the wire approximately 10, 20, 30, 40, 50, 60, 70, 80, 90, 120, 145, 160, 180, 210, 240, 270, 300, 330, or slightly less than 360 degrees (e.g., the wire can rotate at least 10, 20, 30, 40, 50, 60, 70, 80, 90, 120, 145, 160, 180, 210, 240, 270, 300, 330, or slightly less than 360 degrees or at most 10, 20, 30, 40, 50, 60, 70, 80, 90, 120, 145, 160, 180, 210, 240, 270, 300, 330, or slightly less than 360 degrees).
In some embodiments, the connecting element and first and second wire are arranged as depicted in
Reference is made to
It will be appreciated by persons skilled in the art that embodiments of the invention are not limited by what has been particularly shown and described hereinabove. Rather the scope of at least one embodiment of the invention is defined by the claims below.
This application claims benefit of U.S. Provisional Application No. 61/826,012 filed May 21, 2013, which is hereby incorporated by reference in its entirety.
Filing Document | Filing Date | Country | Kind |
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PCT/IL2014/050432 | 5/18/2014 | WO | 00 |
Number | Date | Country | |
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61826012 | May 2013 | US |